Prognosis and Determinants of Survival in Patients Newly Hospitalized for Heart Failure: A Population-Based Study

In contrast to the well-documented mortality risk of patients with heart failure enrolled in clinical trials, the prognosis of unselected patients with heart failure from the community has been less widely studied. Jong et al reviewed the 1-year outcome of 38 702 consecutive patients from the community with first-time admissions for heart failure between 1994 and 1997 in Canada. The 30-day and 1-year case-fatality rates were 11.6% and 33.1%, respectively. Moreover, only young subjects with minimal comorbidity had low mortality rates typically seen in contemporary trials of heart failure. For most subjects who were older, women, and with significant comorbidities, their prognosis remained poor, with 1-year mortality rates reaching over 60%. Despite recent advances in the treatment of heart failure, the persistent high mortality observed in this study is a sobering note to the medical community that there is much more to be done to improve the outcomes of this seriously ill population than is currently believed.

Should We Screen for Hemochromatosis? An Examination of Evidence of Downstream Effects on Morbidity and Mortality

Through an analysis of the Third National Health and Nutrition Examination Survey (1988-1994), and the 1996, 1997, and 1998 National Ambulatory Care Survey, National Hospital Discharge Survey, and Underlying Cause of Death Mortality Files, Mainous et al identified the prevalence of hemochromatosis and the diagnosed morbidity and mortality due to hemochromatosis. While the prevalence of elevated serum transferrin saturation ranged from 1% to 6%, the proportion of diagnosed hemochromatosis utilization of total ambulatory visits, hospitalizations, and deaths was much lower than would be expected due to the prevalence. When white men were examined separately, the relationships remained the same as the general population of adults. The results suggest that recommendations for screening programs may need to be revisited.

A Profile of Military Veterans in the Southwestern United States Who Use Complementary and Alternative Medicine: Implications for Integrated Care

Although civilian users of complementary and alternative medicine (CAM) have been well described, little is known about military veteran users of CAM. In a telephone survey of 508 veterans randomly selected from Southern Arizona VA Health Care System Primary Care patient lists, 49.6% reported CAM use. White ethnicity, higher education, and chronic conditions, such as gastrointestinal problems, insomnia, and asthma, were consistent with civilian CAM users. In addition to ethnicity and education, higher current daily stress and overseas military experience were significant predictors of CAM use by these veterans. Findings also suggest that physicians providing conventional medical care need to be aware of experiences unique to CAM-using military veterans.

Most studies suggest that diabetes mellitus is a stronger coronary heart disease (CHD) risk factor for women than for men, but few have adjusted their results for classic CHD risk factors. Kanaya et al compared the summary odds ratio for CHD mortality and the absolute rates for CHD mortality in men and women with diabetes mellitus. Sixteen studies met all inclusion criteria. In unadjusted and age-adjusted analyses, odds of CHD death were higher in women than in men with diabetes. The multivariate-adjusted summary odds ratio for CHD mortality due to diabetes mellitus was 2.3 (95% confidence interval, 1.9-2.8) for men and 2.9 (95% confidence interval, 2.2-3.8) for women. There were no significant sex differences in the adjusted risk associated with diabetes mellitus for CHD mortality, nonfatal myocardial infarction, and cardiovascular and all-cause mortality. Absolute CHD death rates were higher for diabetic men than women in every age stratum except the very oldest.

Summary odds ratios for each sex are presented by adjustment of study results for white race only. Unadjusted and age-adjusted summary odds ratio show a trend or significant differences by sex, whereas multiple-adjusted results (for age, hypertension, total cholesterol level, and smoking) show no difference by sex. P values are for comparison of odds ratios between men and women in each category.